In 1997, the National Institutes of Health’s National Asthma Education and Prevention Program (NAEPP, a project of the National Institutes of Health) changed its Guidelines for the Diagnosis and Treatment of Asthma to reflect a new approach to asthma management. Tens of thousands of asthma patients are benefiting from stepwise care today.

The stepwise approach recommends starting with aggressive drug therapy to control asthma quickly. Once symptoms are controlled, medications are gradually reduced. Before the 1997 change to the NAEPP guidelines, doctors usually prescribed low doses or milder medications at first, then increased the dosage or chose stronger drugs to achieve control.

Stepwise care reflects a turnaround in how the medical community views asthma. These days, asthma is expected to improve. That’s why you’ll probably need less medication over time because asthma is expected to improve. With proper management, the NAEPP says that everyone who has asthma should be able to live without symptoms.

How stepwise care works

Before stepwise care, the “type” of asthma at diagnosis was a lifetime label. Drug therapy was meant mainly to keep “mild” asthma from turning into “severe” asthma. Stepwise care reverses the logic. Now the goal is to turn “severe” asthma into “mild” asthma.

Today, when a person is first diagnosed, the health care provider will assign an asthma classification based on the severity and frequency of symptoms. Step 1 is classified as mild intermittent, Step 2 is mild persistent, Step 3 is moderate persistent, and Step 4 is severe persistent. Treatment protocols (including medication) are different for each step, with Step 4 therapy the most aggressive and Step 1 the least.

Treatment begins at the same step as your classification, or one step above. For example, if you are diagnosed with Step 2 asthma, therapy may begin with Step 3 medications. Over a period of weeks, months, or even years, your medications are adjusted from Step 3 to Step 2, and finally to Step 1. The goal is to achieve the best asthma control with the least medication.

What to expect during the medication adjustment process

You may experience relapses as stepwise treatment proceeds and medication is adjusted. Your symptoms may improve a little, get a little worse, then improve a lot (or even get a lot worse) as medications are reduced. For example, your health care provider may step down your dosage of inhaled corticosteroids by as much as 25% every two to three months. If you continue to improve, medications will reduced still further.

You may reach a point where the reduced dosage is not enough to control symptoms, putting you at risk for a severe asthma episode. In that event, your doctor will step up your medication, back to where you were before the episode. Once you regain control, your treatment will gradually step back down. The last medication added to your regimen is often the first one to be reduced.

Don’t be discouraged by this two-steps-forward-one-step-back approach. Relapses are a normal part of stepwise care. Keep in mind your goal is overall improvement over time. Keeping a peak flow diary is an objective way to measure the success of treatment, because the readings let you see how much better you’re doing over time.

Your role in stepwise management

Communication with your health care provider is crucial in making the stepwise approach work. Your health care provider needs to know the facts to evaluate the effectiveness of your current medications and treatment.

Follow your health care provider’s instructions, and always give accurate feedback. When you do, you may find that stepwise asthma management will keep you on track to controlling asthma with the least medication.

If you follow your asthma management plan exactly and your symptoms still do not improve over time, talk to your health care provider. Today’s medications and stepwise treatment approach should enable you to live without asthma symptoms. The NAEPP says you should expect nothing less.

This entry was posted on Sunday, July 22nd, 2007 at 7:01 am and is filed under Adult Asthma. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.